Treatment of Small Cell Carcinoma of the Bladder With Chemotherapy and Radiation after Transurethral Resection of a Bladder Tumor

Objectives:Small cell carcinoma of the bladder is a rare, aggressive cancer with a high potential for metastases. We analyzed outcomes of patients with small cell carcinoma of the bladder treated curatively with chemotherapy and radiotherapy with bladder preservation.Materials and Methods:We reviewed the medical records of 11 patients treated with radiotherapy at our institution between 1988 and 2010 for biopsy-proven small cell carcinoma of the bladder clinically localized to the true pelvis. Each patient received transurethral resection of the bladder tumor followed by induction chemotherapy and consolidative radiation or concurrent chemoradiation. After completing radiotherapy, cystoscopy was performed to evaluate local response. Overall survival, distant metastasis-free survival, local-regional control, and complete response rates are reported.Results:The median follow-up was 1.1 years for all patients and 10 years for survivors. Nine patients had clinical T3-T4 disease and 3 had node-positive disease. All patients were treated with conventional radiotherapy (median dose, 59 Gy) and cisplatin-based chemotherapy. Eight patients had a cystoscopy after completing chemoradiation, all of whom had a biopsy-proven complete response. The remaining 3 patients developed a distant metastasis before cystoscopy could be performed. The 3-year overall survival rate was 24%; the distant metastasis-free survival rate was 27%; and the local-regional control rate was 78%. All patients who achieved local control maintained functioning bladders. No Common Terminology Criteria for Adverse Events toxicity scale, version 3.0 late grade 3 genitourinary or gastrointestinal toxicities occurred.Conclusions:Primary chemoradiation provides reasonable local-regional control rates with a functioning bladder, even for patients with locally advanced disease, and is an effective alternative to cystectomy when aiming for bladder conservation.